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Understanding Polymyalgia Rheumatica: Symptoms, Diagnosis, and Treatment

Polymyalgia Rheumatica (PMR) is an inflammatory disorder that causes muscle pain and stiffness, primarily in the shoulders, neck, and hips. It most commonly affects adults over the age of 50, with the highest incidence in people over 70. Though the condition can be painful and disruptive, it is treatable and often responds well to medication.

Common Symptoms

The hallmark symptoms of PMR include:

  • Muscle pain and stiffness, especially in the morning or after periods of inactivity
  • Bilateral discomfort, typically affecting both sides of the body
  • Fatigue and malaise
  • Mild fever
  • Weight loss
  • Limited range of motion in affected areas

Unlike many other forms of arthritis, PMR does not usually cause joint swelling, but the surrounding soft tissues may feel tender.

Causes and Risk Factors

The exact cause of PMR is unknown, but it's believed to involve an abnormal immune response. Some factors that may contribute include:

  • Age: Primarily affects individuals over 50
  • Gender: Women are more commonly diagnosed than men
  • Genetics: A family history may increase risk
  • Geography: More prevalent in people of Northern European descent

PMR is sometimes associated with giant cell arteritis (GCA), a more serious condition that involves inflammation of the blood vessels and can lead to vision loss if not treated.

Diagnosis

There is no single test to confirm PMR. Diagnosis typically involves:

  • Medical history and symptom assessment
  • Blood tests to check for inflammation markers like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein)
  • Physical examination
  • Exclusion of other conditions such as rheumatoid arthritis, lupus, or fibromyalgia

In some cases, imaging tests such as ultrasound or MRI may be used to assess inflammation in soft tissues and joints.

Treatment Options

Treatment for PMR usually involves:

1. Corticosteroids

Low-dose corticosteroids, such as prednisone, are the standard treatment. Most patients experience rapid improvement within days of starting medication. However, long-term use requires careful monitoring due to potential side effects like bone thinning, high blood sugar, and increased risk of infection.

2. Tapering the Dose

Doctors will gradually reduce the steroid dose over months or even years. Relapses can occur, especially if tapering happens too quickly.

3. Pain Management and Lifestyle Adjustments

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage mild symptoms
  • Physical therapy can improve mobility
  • Balanced diet and weight-bearing exercise can protect bone health during steroid use

Outlook

While PMR can be a chronic condition, most people recover within one to two years with proper treatment. Ongoing medical follow-up is important to monitor symptoms, manage medications, and address any complications from long-term corticosteroid use.

Conclusion:

Polymyalgia Rheumatica can significantly affect daily life, but with early diagnosis and proper treatment, it is very manageable. If you're experiencing persistent stiffness or unexplained muscle pain, especially as you age, consult your healthcare provider to explore possible causes and treatment options.